Causes of Insomnia Questionnaire

This short 22 question questionnaire will help you discover what exactly causes your insomnia. Even if you’re not suffering from insomnia, this questionnaire will show you how your sleep be optimised so you can enjoy better quality of sleep and wake refreshed.

Fill out your answer to each question below, press submit and you’ll receive your results straight away.

The questionnaire tests your sleep habits against these 5 common causes of insomnia:

  • Learned Insomnia
  • Psychological
  • Sleep Environment
  • Sleep Hygiene
  • Mistiming Sleep

In most cases your insomnia will be the result of a range of these causes, but the questionnaire will help you identify which cause is having the greatest effect over your sleep. It will then explain the next best course of action depending on the cause of your insomnia.

Note: This questionnaire doesn’t test for any sleep disorders, age or illness as factors for causing insomnia. To discover how age can affect your sleep, see the How Sleep Changes with Age article, and here for how illness can affect your sleep.

Q1. Which of these activities do you do in your bedroom?
(leave blank if none)

Eat
Watch TV
Play Games

Q2. Do you think about the day's events while in bed?

Often
Sometimes
Never

Q3. How long do you usually spend awake in bed each night?

0 - 30 minutes
30 - 60 minutes
1 hour - 2 hours
2 hours plus

Q4. How long have you had problems sleeping?

I don't have any problems sleeping
Days
Weeks
Months
Years

Q5. Do you feel stressed during the day or in bed if you can't sleep?

Often
Sometimes
Never

Q6. Do you feel depressed or upset during the day or at night?

Often
Sometimes
Never

Q7. For any reason, do you feel scared while in bed?

Often
Sometimes
Never

Q8. Do you ever worry about not being able to get to sleep?

Often
Sometimes
Never

Q9. Do you look at a clock in your bedroom during the night
while in bed?

Often
Sometimes
Never

Q10. On a scale of 1 - 5, how comfy would you rate your bed?

1
2
3
4
5

Q11. Do you ever get any aches or pains from lying on your bed (that you wouldn't normally)?

Often
Sometimes
Never

Q12. How much light enters your room at night while you sleep?

None
A little
Quite a bit
Lots

Q13. When you sleep away from home, how well do you sleep?

Better
Worse
Same - no change

Q14. Which of these on an average day might you do 2 - 3 hours before bedtime? (leave blank if none)

Drink alcohol
Smoke
Have a drink containing caffeine (tea, coffee)
Eat sugary foods (such as chocolate)
Heavy exercise
Have a meal

Q15. How best describes your activities just before you go to bed?

Stressful
Energetic
Calming
Mellow

Q16. Do you sometimes go to bed when you're not yet sleepy?

Often
Sometimes
Never

Q17. On a scale of 1 - 5, how active would you describe yourself?

1
2
3
4
5

Q18. How regular would you rate your mealtimes on a scale of 1 - 5?

1
2
3
4
5

Q19. Do you have the same number of meals each day?

Always
Sometimes
Never

Q20. By how much does the time you wake up vary from
day to day?

It doesn't change
1 - 30 minutes
30 minutes to an hour
Over an hour

Q21. Do you sometimes take any unplanned naps during the day at random times?

Often
Sometimes
Never

Q22. Do you take sleep medication regularly?

Often
Sometimes
Never

 

Previous: Sleep Tests
Next: Causes of Insomnia Questionnaire Results


Recommended Book: The Insomia Answer

The Insomia AnswerInsomnia is created by many factors and not everyone suffers from insomnia for the same reason. This book provides the answers to a wide range of insomnia problems and helps you identify the source of your insomnia.


See all Recomendations | Buy from Amazon